Glucagon-like peptide-1 (GLP-1) receptor agonists: applications in childhood diabetes and obesity

Glucagon-like 1 receptor agonists (GLP-1 RAs) are a class of synthetic incretin analogues that were originally developed to treat hyperglycaemia in adults with type 2 diabetes. Their mechanisms of action include effects on body weight through reducing appetite and slowing gastric emptying and these have been exploited in new indications for weight reduction in obesity. Most recently, convincing evidence has been published for their benefits in obstructive sleep apnoea, renal function in diabetes, and possibly anti-ageing. Studies in children have mainly focussed on childhood type 2 diabetes and obesity, and their efficacy has led to licensing for children from 10 years of age (type 2 diabetes) and 12 years (obesity). Early studies of these agents as add-on therapies in type 1 diabetes showed efficacy but significant risks of hypoglycaemia. This review will discuss the history and development of GLP-1 RAs in the context of the rising prevalence of childhood obesity and type 2 diabetes, the evidence for their effectiveness in children, and potential future applications such as in children with type 1 diabetes.